Prof Lombadri Report - Second X-linking Congress in Zurich

Sajeev · Post by **Sajeev** » 2006-12-21, 04:34

First of all Merry Christmas to all at this forum... I copy below a short report from Prof Lombadri.

"Dear Sajeev,

I’m here to give you a short report on the second X-linking Congress in Zurich this year.

1) First of all, the colleagues coming from all over the world, were doubled with a total presence of 240 ophthalmologists. All the members of the “Multicentral Study” reported in all the patients treated with the X-linking an improvement of 18% in the reduction of the k-readings (= a reduction of the curvature).

2) Most of them also reported a complication in 10-15% of the treated cases with an Haze that has been resolved with a local cortisone treatment from 1 to 3 months and it has been reported only one case that has not been yet resolved.

3) The central and para central thickness of 400 microns requested to be good candidate for the treatment is due to the fact that U.V. will not harm the endothelial cells of the cornea only if this thickness above them will be preserved. Prof. Theo Sailer has used some small tricks to improve up to 400 microns corneas that were 300-350 microns thickness.

4) The only Firm today constructing ultra violet machineries with C.E. approval is an Italian Firm. The German and the American ones have not yet reached that approval.

5) It has been suggested the possibility to treat with general oral treatment with Riboflavine and C vitamin. Both of them have a great capability to concentrate the normal U.V. (sun irradiation) into the cornea.

6) In the meantime I’m studying a possible use, in selected cases, of X-linking during Mini A.R.K. praesidia.

7) Up today with a maximum follow up of approximately three years, when X-linking is used with the above mentioned restricted use of 400 central and paracentral cornea thickness, there is no evidence of any damage to endothelial cells, crystalline lens, retina.

8 ) This is the summary of the most important news coming out from this year Congress.

I wish you and your family all the best for the New Year and a Merry Christmas

Prof. Massimo Lombardi"

RobertM · Post by **RobertM** » 2006-12-21, 11:26

Quote | Reply
A study from Pr Seiler : demarcation line
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Dears friends,
I just copy a new study about C3R from Professor Seiler.
Best regards.

Act.

Corneal cross-linking-induced stromal demarcation line.

Seiler T,

Hafezi F.

From the Institute for Refractive and Ophthalmic Surgery, Zurich, Switzerland.

PURPOSE:: Corneal collagen cross-linking by UVA/riboflavin (X-linking) represents a new method for the treatment of progressive keratoconus and currently is under clinical study. To avoid UVA irradiation damage to the corneal endothelium, the parameters for X-linking are set in a way that effective treatment occurs only in the first 300 mum of the corneal stroma. Here, X-linking not only strengthens the biomechanical properties of the cornea but also induces keratocyte apoptosis. To date, the effectiveness of treatment could be monitored only indirectly by postoperative follow-up corneal topographies or using corneal confocal microscopy. Here we describe a corneal stromal demarcation line indicating the transition zone between cross-linked anterior corneal stroma and untreated posterior corneal stroma. The demarcation line is biomicroscopically detectable in slit-lamp examination as early as 2 weeks after treatment. METHODS:: X-linking was performed in 16 cases of progressive keratoconus, and corneas were examined biomicroscopically and by means of corneal topography and pachymetry before and after treatment. RESULTS:: In 14 of 16 cases, a thin stromal demarcation line was visible at a depth of approximately 300 mum over the whole cornea after X-linking treatment. CONCLUSION:: This newly observed demarcation line may result from differences in the refractive index and/or reflection properties of untreated versus X-linked corneal stroma and represents an effective tool to biomicroscopically easily monitor the depth of effective X-linking treatment in keratoconus.

Yarsky

Executive

Posts: 376
Date: Sun Dec 10 11:41 PM, 2006
Views: 36
Quote | Reply
RE: A study from Pr Seiler : demarcation line
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RobertM · Post by **RobertM** » 2006-12-21, 11:32

.....und hier noch etwas interessantes....was bedeutet "forme fruste Keratokonus " gleich späte Keratektasie???? Fragen über Fragen....
viele Grüße
Robert

Topography-guided surface ablation for forme fruste keratoconus.Koller T, Iseli HP, Donitzky C, Ing D, Papadopoulos N, Seiler T.
Institut fur Refraktive und Ophthalmochirurgie, Zurich, Switzerland.

PURPOSE: To evaluate the efficacy of customized surface ablation in cases of forme fruste keratoconus. DESIGN: Prospective noncomparative case series. PARTICIPANTS: Eleven eyes of 8 contact lens-intolerant patients with forme fruste keratoconus treated at the Institute of Refractive and Ophthalmic Surgery and the University Eye Clinic Zurich. INTERVENTION: Topography-guided customized surface ablation by means of a scanning spot excimer laser. MAIN OUTCOME MEASURES: Visual acuity, refraction, quality of vision (ghosting), corneal topography including the Zernike parameter Z3. RESULTS: Statistically significant reduction of manifest refractive error, corneal irregularity, and ghosting. The spherical equivalent was reduced by -2.8+/-0.62 diopters (D) (P = 0.0007), the cylinder by 1.34 +/- 0.18 D (P = 0.015), Z3 was reduced by 41% (P<0> or =1 lines in best spectacle-corrected visual acuity; however, 7 of 11 eyes gained > or = 1 line. CONCLUSION: Topography-guided surface ablation is a promising option to rehabilitate vision in contact lens-intolerant patients with forme fruste keratoconus.

PMID: 17157132 [PubMed - in process]
Related LinksTopography-guided customized laser-assisted subepithelial keratectomy for the treatment of postkeratoplasty astigmatism. [J Cataract Refract Surg. 2006] PMID: 16814052 Correction of irregular astigmatism with excimer laser assisted by sodium hyaluronate. [Ophthalmology. 2001] PMID: 11425683 Wavefront-supported photorefractive keratectomy with the Bausch & Lomb Zyoptix in patients with myopic astigmatism and suspected keratoconus. [J Refract Surg. 2006] PMID: 16805115 INTACS inserts for treating keratoconus: one-year results. [Ophthalmology. 2001] PMID: 11470691 Treatment of myopia and myopic astigmatism by customized laser in situ keratomileusis based on corneal topography. [Ophthalmology. 2000] PMID: 11054333 See all Related Articles...

Sajeev · Post by **Sajeev** » 2006-12-21, 23:53

Hi Robert,

At the risk of loosing my expaination through the web and due to language differances, I will try to explain what "forms fruste Keratokonus equal late Keratektasie" means.

1) Forme fruste keratoconus, is a non progressing type of Keratoconus, which still needs to be screened out before laser surgery is done, but its seems topography-guided surface ablation lasers can take away the most minimal amount of tissue from the cornea as needed for correction, and so its thought to be safer to use (may be combined with Crosslinking might me a route this may go)...time will tell us...

2) Kera-elastisa (which is a lot like keratoconus in symptoms and the irregularty it causes to the cornea) happens if too much corneal tissue has been removed or if there was undetected Keratoconus present before laser treatment was done. For Kera-elastisa to appear it may take several years after the laser surgery, and this is why they call it a "late" complication.

All the best